Healthcare Provider Details

I. General information

NPI: 1972883767
Provider Name (Legal Business Name): SARAH DEEN BILANCIA PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2011
Last Update Date: 12/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 RIVER RD SUITE 6
SUMMIT NJ
07901-1452
US

IV. Provider business mailing address

45 RIVER RD SUITE 6
SUMMIT NJ
07901-1452
US

V. Phone/Fax

Practice location:
  • Phone: 908-522-6610
  • Fax:
Mailing address:
  • Phone: 908-522-6610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number4839
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number018488-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: